New article you should know about by Dr. Cecilia Gigena
"Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema"
Authors: Robert M. Eeftinck Schattenkerk a , 1 , ∗, Laurens D. Eeftinck Schattenkerk a , b , 1 , Gijsbert D. Musters a , Joost van Schuppen c , Justin R. de jong a , Ramon R. Gorter a , Wouter J. de Jonge b , d , Ernest L.W. van Heurn a , b , Joep PM. Derikx
ABSTRACT
Introduction
Contrast enemas are often made prior to stoma reversal in order to detect distal intestinal strictures distal of the stoma. If untreated these strictures can cause obstruction which might necessitate redo-surgery. However, the value of contrast enemas is unclear. Therefore, we aim to evaluate the contrast enema’s diagnostic accuracy in detecting strictures in children with a stoma.
Methods
Young children ( ≤3 years) treated with a stoma between 1998 and 2018 were retrospectively included. The STARD criteria were followed. Patients treated for anorectal malformations and those that died before stoma reversal were excluded. Surgical identification of strictures during reversal or redo- surgery within three months was used as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) reflected diagnostic accuracy.
Results
In 224 included children, strictures were found during reversal in 10% of which 95% in patients treated for necrotizing enterocolitis. Contrast enema was performed in 68% of all patients and detected 92% of the strictures. In the overall cohort, the sensitivity was 100%, specificity 98%, PPV 88% and NPV 100% whilst the AUC was 0.98. In patients treated for NEC, the sensitivity was 100%, specificity 97%, PPV 88% and NPV 100% whilst the AUC was 0.98.
Conclusion
Strictures prior to stoma reversal seem to be mainly identified in patients treated for NEC and not in other diseases necessitating a stoma. Moreover, the contrast enema shows excellent diagnostic accuracy in detecting these strictures. For this reason we advise to only perform contrast enemas in patients treated for NEC.
Level of Evidence: II
Type: video · 0 min · posted 2023-04-26 Canonical: https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603 ## Chapters - [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) Contrast Enema Utility in Stoma Reversal ## Statements - "The study was retrospective and conducted in the Netherlands between 1998 and 2018" — Cecilia Gigena (epidemiological) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "The study included patients under three years old who underwent stoma reversal" — Cecilia Gigena (epidemiological) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "244 patients were included in the study" — Cecilia Gigena (epidemiological) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "10% of patients developed strictures" — Cecilia Gigena (epidemiological) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "95% of strictures occurred in patients with necrotizing enterocolitis" — Cecilia Gigena (clinical) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "68% of all patients had a contrast enema prior to stoma reversal" — Cecilia Gigena (epidemiological) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "Contrast enema was able to detect 92% of strictures" — Cecilia Gigena (clinical) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) - "Contrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis" — Cecilia Gigena (opinion) [0:00](https://library.globalcastmd.com/watch/routine-contrast-enema-prior-to-stoma-reversal-seems-only-required-following-treatment-for-necrotizing-enterocolitis-an-evaluation-of-the-diagnostic-accuracy-of-the-contrast-enema-6603?t=0) ## Transcript Do you always do a contrast enema prior to stoma reversal? Hi, I'm Cecilia Higiene from Cincinnati Children's Hospital and I think this is an article that you should know about. This is a retrospective study done in Netherlands between 1998 and 2018. They looked at patients under three years old that got a stoma reversal to see if they had contrast enema prior to it and if they were able to detect strictures. And what did they find? They gathered 244 patients. Of them, 10% got strictures. 95% had a necrotizing enterocolitis. Of all the patients, only 68% had a contrast enema prior to the stoma reversal and was able to detect 92% of the strictures. So it seems that contrast enema prior to stoma reversal is only useful if patients had NEC. ncx. nc. o s s --- Not medical advice · citation policy: https://library.globalcastmd.com/ai